Respect patients’, not hospitals’, end-of-life wishes

Advance directives about health care at the end of life have become common in America. Yet imagine those written statements of an individual’s wishes regarding medical treatment being thwarted — people kept alive indefinitely against their will — because of someone else’s religious beliefs.

The U.S. Supreme Court will hear oral arguments Wednesday in a case whose outcome could not only prevent tens of thousands of women from getting reproductive health care services, but also could eliminate end-of-life care options for millions of Americans.

The plaintiffs in the case, Zubik vs. Burwell, include Catholic-affiliated organizations that object to a provision in the Affordable Care Act. The religious nonprofits object to the regulations that allow them to opt out of including coverage of birth control in their health insurance plans simply by filling out a form or notifying federal officials stating their objections.

The insurance company then pays for and provides the coverage to women directly; the plaintiffs are not required to fund or provide the health care. However, the plaintiffs argue that the mere act of filling out the objection form offends their right to religious liberty because it forces them to violate Catholic teachings that prohibit “cooperating” in another person’s immoral conduct.

Alarmingly, an argument similar to the plaintiffs’ could be made by a health care provider who morally objects to a medically sound health care decision by a patient or surrogate, or to a provision in an advance directive for health care, such as a do-not-resuscitate order or declining a ventilator or feeding tube.

If the plaintiffs in Zubik vs. Burwell prevail, it would upend statutory mandates in California and 46 other states requiring an objecting health care provider to cooperate in the patient’s transfer to another health care provider who will comply.

The result would be to impair almost every American’s constitutional right to refuse unwanted medical treatment.

Obamacare debate

Issues of conscience inevitably will rise in situations where patients’ health care decisions and advance directives are at odds with the Ethical and Religious Directives for Catholic Health Care Services to which Catholic hospitals adhere.

For example, advance directives commonly include provisions against the use of feeding tubes. But Directive No. 58 imposes an obligation to provide “medically assisted nutrition and hydration for those who cannot take food orally,” which “extends to patients in chronic and presumably irreversible conditions (e.g., the ‘persistent vegetative state’) who can reasonably be expected to live indefinitely if given such care.” A Catholic hospital might very well refuse to comply with a patient’s decision, whether spoken directly or set forth in an advance directive, to decline tube feeding.

As we await the ruling in Zubik vs. Burwell by our nation’s highest court, the fate of millions of Americans’ personal health care decisions, and the fate of statutory transfer mandates in 47 states, hangs in the balance.